Metastasectomy by video-assisted thoracic surgery (VATS)
Metastasectomy is one of the most frequent procedures undertaken by thoracic surgeons, and its role has been validated by numerous retrospective studies. There are basic oncologic criteria for pulmonary metastasectomy, which include control of the primary cancer, no extrathoracic metastases, possibility of complete resection of the metastatic lung nodules, and patient good performance. With the progresses made in systemic treatment, a multidisciplinary discussion should be carried out before taking the patient for surgery. Video-assisted thoracic surgery (VATS) is already stablished as an important tool in the treatment of lung cancer, but its role in pulmonary metastasectomy has been a matter of debate. There are not controlled prospective data about the issue. However, in light of the retrospective data available, VATS can be used for metastasectomy, having in mind that complete resection of all metastatic disease is the main goal of this kind of surgery. VATS in also an interesting way to thoroughly stage the pleural cavity, the mediastinum, and the lung surface, before making a larger incision to palpate the lungs.